IRS and state forms where a clinician certifies blindness or permanent and total disability so a patient can claim a tax credit, deduction or property tax exemption.
Several tax benefits depend on a clinician's statement that a taxpayer is blind or permanently and totally disabled. At the federal level, the physician's statement in the Schedule R instructions supports the Credit for the Elderly or the Disabled, and an eye doctor's statement supports the higher standard deduction for blindness. Most state forms are for property tax relief, such as Florida's DR-416, the Illinois PTAX-343-A, Ohio's DTE 105E and North Carolina's AV-9A. New York's IT-221 covers the state disability income exclusion.
Most of these forms go back to the patient, not to the agency. The IRS statements are kept with the taxpayer's records and are not filed, and state certificates usually travel with the applicant's exemption or rebate application to the county assessor, appraiser or auditor. Harris County's GTA:IAD:013 is an exception: the physician mails it to the appraisal district. Several states accept an SSA determination instead. Vero Documents fills PDF forms from the visit note and the chart; the clinician reviews and signs.
Physician-signed diagnosis of the relevant impairment(s), used when an individual without SSI/SSDI qualifies to open a tax-advantaged ABLE (529A) account by disability certification.
Ophthalmologist or optometrist certifies that the taxpayer's best-eye corrected vision is no better than 20/200 or the visual field is 20 degrees or less (and whether it will improve), supporting the additional standard deduction for blindness.
Eye doctor certifies vision no better than 20/200 in the better eye with correction, or a visual field of 20 degrees or less, so the taxpayer can claim the additional standard deduction for blindness.
Physician certifies that a taxpayer under 65 was permanently and totally disabled on retirement (or 1/1/1976-77) so the taxpayer can claim the Credit for the Elderly or the Disabled.
Treating physician swears that a homeowner is permanently and totally disabled (and since when) for the Alabama H-3 total homestead exemption from state and county property tax.
Physician, psychologist or psychological examiner certifies a dependent's diagnosis of a developmental disability (autism, cerebral palsy, Down syndrome, epilepsy, intellectual disability) originating before age 22 so the taxpayer can claim the Arkansas developmental disabilities credit.
BOE-19-DCPhysician or surgeon certifies that a homeowner is severely and permanently disabled and states the disability-related requirements of a replacement home, so the Proposition 19 base-year value transfer (BOE-19-D) can be granted.
BOE-62-APhysician certifies that a claimant or spouse is severely and permanently disabled for the one-time base-year value transfer under Revenue and Taxation Code section 69.5 (Proposition 110 rules for earlier transfers).
Physician certifies that a homestead owner is totally and permanently disabled (quadriplegia, paraplegia, hemiplegia, legal blindness, or another disability requiring a wheelchair) for the Florida property-tax exemptions under s. 196.101 and the $500 disability exemption.
Physician certifies that a first responder is totally and permanently disabled by a line-of-duty impairment, for the full homestead property-tax exemption under s. 196.102.
Optometrist certifies that a homestead owner is totally and permanently disabled due to legal blindness for Florida property-tax exemptions.
Physician, optometrist or audiologist certifies blindness, deafness or total and permanent disability so the taxpayer can claim Hawaii's special income-tax and general-excise-tax exemptions.
Clinician certifies, using Social Security Administration disability criteria, that a homeowner is disabled so the county can grant the Homestead Exemption for Persons with Disabilities (HEPD) when no SSA letter or Class 2 disability ID is available.
Qualified medical practitioner certifies that a homestead applicant is a totally disabled veteran (non-service-connected) or has a qualifying permanent disability (lost mobility without aid, >75% disability of both arms, bilateral arm amputation) for the Nebraska homestead exemption categories 2 and 3.
Qualified licensed medical practitioner certifies that a homestead applicant was an inpatient or incapacitated between February 2 and June 30, allowing a late homestead exemption application.
Physician certifies on page 2 that a taxpayer who retired on disability was permanently and totally disabled, so the taxpayer can exclude disability pay from New York State, NYC and Yonkers income tax.
Physician certifies a resident's permanent physical impairment and how a home improvement accommodates it so the local assessor can exempt the added value of accessibility improvements (RPTL 459).
Physician certifies a crime victim's permanent physical impairment and how a home improvement accommodates it for the RPTL 459-b partial exemption.
North Carolina physician (or authorized government agency) certifies that an applicant was totally and permanently disabled and under their care on January 1, for the Elderly or Disabled Homestead Exclusion and Circuit Breaker deferral.
Physician certifies that an applicant under 65 is permanently and totally disabled for the North Dakota homestead property tax credit or renter's refund (NDCC 57-02-08.1).
Physician or psychologist certifies that the applicant was permanently and totally disabled on January 1 so the home qualifies for Ohio's homestead exemption (ORC 323.151).
Physician certifies, using Social Security Act standards, that a Property Tax/Rent Rebate claimant aged 18-64 who lacks SSA/RRB proof is permanently and totally disabled.
Physician certifies that a Harris County homeowner is disabled (unable to engage in substantial gainful activity for 12+ months, or blind 55+) for the Texas disability residence homestead exemption.
REV 64 0095Doctor certifies the date a person became disabled and whether they can engage in substantial gainful activity (and until when, or permanently) for the senior citizen and people with disabilities property tax exemption/deferral.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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A Florida-licensed physician, either an MD under chapter 458 or a DO under chapter 459, certifies total and permanent disability on the DR-416: quadriplegia, paraplegia, hemiplegia, legal blindness or another disability requiring a wheelchair. For legal blindness alone, a Florida optometrist can use the DR-416B instead. The patient presents it to the county property appraiser by March 1. Some exemptions need two physicians' certifications, and a VA letter can substitute.
It certifies that a taxpayer under 65 was permanently and totally disabled on retirement, so the taxpayer can claim the Credit for the Elderly or the Disabled. The statement is printed in the Schedule R instructions, not as a separate form, and the taxpayer keeps it instead of filing it. If the physician signs line B, meaning no reasonable probability of improvement, a new statement is not needed in later years.
When a homeowner applies for the Homestead Exemption for Persons with Disabilities without a Social Security Administration letter or a Class 2 disability ID. An Illinois-licensed physician, advanced practice nurse or physician assistant, or an optometrist for visual impairment only, certifies disability using SSA criteria. The form goes back to the applicant, who files it with Form PTAX-343 at the Chief County Assessment Office. It states that the applicant pays any physician's costs.
Yes. For the higher standard deduction for blindness, an ophthalmologist or optometrist certifies that best-eye corrected vision is no better than 20/200, or the visual field is 20 degrees or less, and whether the condition will improve. There is no IRS form; Publication 501 sets the content, so it is written as a letter. The taxpayer keeps it with their records, and if the condition will not improve, one statement can serve future years.